Clinical and Prognostic Significance of Urinary Trypsin Inhibitor in Patients with Hepatocellular Carcinoma After Hepatectomy

Isao Kikuchi MD, Hiroshi Uchinami MD, PhD, Hiroshi Nanjo MD, PhD, Manabu Hashimoto MD, PhD, Akio Nakajima MD, PhD, Makoto Kume MD, PhD, Ali Mencin MD, Yuzo Yamamoto MD, PhD
Hepatobiliary Tumors
Volume 16, Issue 10 / October , 2009

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Abstract

Background

Urinary trypsin inhibitor (UTI), produced in the liver, has been considered to suppress inflammation. The production of UTI may decrease after a hepatectomy and thereby increase the incidence of postoperative inflammation. This study investigated whether the changes in the UTI level affected the postoperative course in patients undergoing a hepatectomy for hepatocellular carcinoma (HCC). The prognostic significance of UTI was also analyzed.

Methods

The perioperative plasma UTI was measured in 25 HCC patients who underwent hepatic resection, and the correlation between the kinetics of UTI and clinicopathological factors was investigated. The expression of UTI in the resected specimens was examined by immunohistochemistry in 65 patients. Expression of UTI in the cancer cells were then correlated to both the liver pathology and the clinical outcomes in the corresponding patients.

Results

The plasma UTI level greatly decreased on the first postoperative day. This decrease significantly correlated with the resected tumor volume (r_s = −.530, P = .006), but it had no influence on inflammatory complications. Immunohistochemistry revealed UTI expression in both noncancerous and cancerous lesions. An overexpression of UTI in HCC tissue was found to be an independent prognostic factor for early recurrence (P = .006).

Conclusions

Although UTI plasma levels were noted to decrease after the removal of an HCC tumor, this decrease did not lead to an increase in inflammatory complications. However, overexpression of UTI in cancer was found to be a risk factor for tumor recurrence after resection, suggesting that UTI expression may be a useful prognostic marker.

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